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Infectious sacroiliitis: MRI- and CT-based assessment of disease extent, complications, and anatomic correlation

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Abstract

Objective

To describe the frequency of MR and CT features of infectious sacroiliitis (ISI) and assess its extent and complications

Materials and methods

This retrospective study included patients with ISI who were evaluated between 2008 and 2021 in a single center. Two radiologists reviewed MRI and CT images to determine the anatomical distribution (unilateral/bilateral, iliac/sacral bone, proximal/middle/distal), severity (bone marrow edema [BME]/periostitis/erosions), concurrent infection (vertebral/nonvertebral), and complications (abscess/probable adjacent osteomyelitis/cavitation/devitalized areas/sequestrum/pelvic venous thrombosis) of ISI. Interobserver reproducibility was assessed. Correlation analysis evaluated the effect of the causative microorganism on severity. Two human bodies were dissected to outline possible ways that ISI can spread.

Results

Forty patients with ISI (40 years ± 22; 26 women) were evaluated. Ten patients had bilateral ISI. Concurrent vertebral infection was associated in 15% of cases. Reproducibility of sacral BME, periostitis, and reactive locoregional abnormalities was perfect (κ = 1). Reproducibility was low for erosion count (κ = 0.52[0.52–0.82]) and periarticular osteopenia (κ = 0.50[0.18–0.82]). Inflammatory changes were BME (42/42 joints), muscle edema (38/42), and severe periostitis along the ilium (33/37). Destructive structural changes occurred with confluent erosions (iliac, 20/48; sacral, 13/48), sequestrum (20/48), and cavitation (12/48). Complications occurred in 75% of cases, including periarticular abscesses (n = 30/47), probable adjacent osteomyelitis (n = 16/37), and pelvic thrombophlebitis (n = 3). Tuberculous ISI (6/40) correlated with sclerosis (rs = 0.45[0.16; 0.67]; p < 10−2) and bone devitalization (rs = 0.38[0.16; 0.67]; p = .02). The anatomical study highlighted the shared venous vascularization of sacroiliac joints, pelvic organs, and mobile spine.

Conclusion

Complications of ISI are frequent, including abscesses, adjacent osteomyelitis, and periostitis. ISI had bilateral involvement nonrarely and is commonly associated with another spinal infection.

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Data Availability

The data that support the findings of this study are available from the corresponding author, M.C., upon reasonable request.

Abbreviations

ISI:

Infectious sacroiliitis

SIJ:

Sacroiliac joint

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Acknowledgements

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.

The authors thank Gilles Missenard MD, (Department of Orthopedic Surgery, Gilles Missenard Hospital) for his assistance in performing the en bloc resection of the sacroiliac joint, as well as for his valuable comments during the anterior dissection of the sacroiliac joint.

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Authors and Affiliations

  1. Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France

    Sarah Interligator, Guillaume Cluzel, Matthieu Devilder, Jessica Ghaouche, Albane Fleury, Florian Petit Lemaire, Catarina Valente & Maud Creze

  2. Department of Pharmacy, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France

    Antoine Le Bozec

  3. Department of Radiology, Hôpital Sainte-Marguerite, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France

    Daphne Guenoun

  4. Department of Radiology, Hôpital Raymond Poincaré, Assistance-Publique des Hôpitaux de Paris, 104 Boulevard Raymond Poincaré, 92380 Garches, Paris, France

    Robert-Yves Carlier

  5. Laboratoire d’Imagerie Biomedicale Multimodale Paris-Saclay, BioMaps, Paris-Saclay University, 4 place du Général Leclerc, 91401 Orsay, Paris, France

    Maud Creze

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  1. Sarah Interligator
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Correspondence to Maud Creze.

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Interligator, S., Le Bozec, A., Cluzel, G. et al. Infectious sacroiliitis: MRI- and CT-based assessment of disease extent, complications, and anatomic correlation. Skeletal Radiol (2023). https://doi.org/10.1007/s00256-023-04535-w

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